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A Medicaid and CHIP state plan is an agreement between a state and the Federal government describing how that state administers its Medicaid and CHIP programs. It gives an assurance that a state will abide by Federal rules and may claim Federal matching funds for its program activities. The state plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative activities that are underway in the state.
When a state is planning to make a change to its program policies or operational approach, states send state plan amendments (SPAs) to the Centers for Medicare & Medicaid Services (CMS) for review and approval. States also submit SPAs to request permissible program changes, make corrections, or update their Medicaid or CHIP state plan with new information.
Persons with disabilities having problems accessing the SPA PDF files may call 410-786-0429 for assistance.
Summary: This SPA provides New York with approval to provide 12 months of continuous postpartum coverage to individuals enrolled in its Medicaid program.
Summary: This SPA is to make a change regarding when benefits are provided. Once the reasonable opportunity period is provided, the agency furnishes benefits on the first day of the month of application.
Summary: This State Plan Amendment increases the inpatient hospital per-diem rate of reimbursement for extended observation bed (EOB) services in hospital-based comprehensive psychiatric emergency programs (CPEP), subsequent to a CPEP full or triage and referral visit and where the beneficiary remains in the CPEP for longer than 24 hours.
Summary: To include coverage and reimbursement for gambling treatment provided to individuals receiving services from the Office of Addiction Services and Supports (OASAS) certified services, pursuant to 14 NYCRR Part 818 Chemical Dependence Inpatient Services, 14 NYCRR Part 820 Residential Addiction Rehabilitation Services, 14 NYCRR Part 822 Outpatient Addiction Rehabilitation Services, 14 NYCRR Part 825 Integrated Outpatient Addiction Rehabilitation Services and 14 NYCRR Part 857, with the OASAS gambling designation, when services are for gambling disorder/problem gambling only.
Summary: This SPA pays participating programs at enhanced rates for approved services. Credentialed providers would receive a 10% increase over the fee-for-service fee schedule. Providers with a credential of master’s level or above would receive a 20% increase. Residential providers would receive a 15% increase.
Summary: This amendment expands school-based health services (SBHS) under the Rehab benefit by 1) adding specialized transportation to school-based rehabilitative services and 2) increases reimbursement for students covered under the Individuals withDisabilities Education Act (IDEA). The SPA also introduces a new reimbursement methodology for SBHS.
Summary: This Alternative Benefit Plan amendment is to add coverage and reimbursement of community violence prevention services performed by certified violence prevention professionals as a new benefit.
Summary: This SPA makes changes to the definition of home with settings in which normal life activities take place to better align the language with CMS regulations from 2017, and was originally approved on December 1, 2021.
Summary: CMS is approving this time-limited state plan amendment to allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency. The purpose of this amendment is to extend, without modifications, the 5% increase in payment rates for ODDS services and settings approved under DR SPA OR-22-0028 for a temporary period of 5/12/23 through 6/30/23.
